Botulinum toxin prescription in the treatment of spasticity in the neurological rehabilitation service: 2012 to 2015 assessment.

OBJECTIVE: Botulinum toxins are often prescribed in aftercare and neurological rehabilitation services. In our hospital, they are exponentially used in the treatment of spasticity. The objective of this study is to make an assessment of their use over the period 2012-2015.

MATERIAL/PATIENTS AND METHODS: All the botulinum toxin prescriptions are followed by the chemists. A traceability form allows to collect information about the patient, the prescriber, the medicine and its dose, the cost, and the indication. All these data are saved in an Excel file. The data from 2012 to 215 concerning the spasticity have been extracted and analysed.

RESULTS: Speaking about figures, botulinum toxins represented an amount of €118,020 excluding tax in 2012 to €224,239 in 2015. The number of toxin injection sessions went from 435 (1.61 sessions per patient per year) to 643 (1.86 sessions per patient per year). The average dose in international unit (IU) for the treatment of the upper and/or upper limb spasticity increased during this period, going from 164 to 214 IU for Botox and from 595 to 793 IU for Dysport. In 2015, the treatment costs are quite similar for both molecules, with an average injection session cost of €300. The number of patients for whom the cost exceeds the amount supported by the hospital doubled over 3 years (from 20 to 42%), in relation to the increase either of the doses injected per muscle or of the number of treated muscles.

DISCUSSION-CONCLUSION: This follow-up shows the complexity of the financial support of spasticity, and also of the economic and clinical monitoring of botulinum toxin administration. This must be carried on and refined, especially concerning the indication follow- up in association with the doctors (muscles treated per session, regulation compliance, treatment average costs).